January 6, 2013
A new brain stimulation therapy for depression is coming to Madison this week.
Transcranial magnetic stimulation, or TMS, uses a magnetic coil positioned on the head to activate targeted brain cells.
TMS is meant for patients who haven’t been helped by medication and seek an alternative to electroconvulsive therapy, the decades-old treatment in which a seizure in induced.
Connections Counseling will open the TMS Center of Madison on Monday at its clinic on Madison’s West Side through a joint venture with Rosecrance Health Network of Rockford, Ill.
During TMS, patients sit in what looks like a dental chair while magnetic pulses, like those from an MRI machine, stimulate nerve cells thought to be involved in mood regulation.
That’s different from electroconvulsive therapy, or ECT, which requires patients to take a muscle relaxant and be under general anesthesia. Those steps help them withstand the seizure generated by current from electrodes on their head.
Madison’s three main hospitals offer ECT. But TMS, approved by the Food and Drug Administration in 2008, hasn’t been available in the area until now. It is offered in Mequon, Stevens Point and Wauwatosa.
Shelly Dutch, director of Connections Counseling, said some patients with depression struggle to work, maintain relationships and avoid suicide despite taking a variety of medications.
She said some worry about side effects from ECT, which can include memory loss.
“The number one attraction for us is that (TMS) is a non-invasive process,” Dutch said. “If they can have a quality of life that is functional, this is definitely a therapy we wanted to invest in.”
Rosecrance has offered TMS in Rockford since 2010 and treated more than 40 patients there, said Dr. Thomas Wright, a psychiatrist who is chief medical director.
Half of the patients have stopped being depressed and others have experienced improvements, Wright said. “Virtually all of our patients have responded to some degree,” he said.
The therapy typically involves five treatments a week for about six weeks, with each session lasting about 40 minutes. Sometimes follow-up treatments are advised.
The average cost is about $8,000. Anthem Blue Cross and Blue Shield of Wisconsin covers TMS, but no insurers based in the Madison-area do. Wright said doctors will help patients request coverage.
About 15 million American adults have major depression each year, according to the National Institutes of Health. In about a third, medications don’t help, Wright said.
The FDA approved TMS largely based on a 2007 study of 301 patients with major depression who hadn’t responded to medication.
Depression improved significantly after six weeks in 14 percent of the patients who got TMS, compared to 5 percent of those who got a fake treatment. Some recent studies have found higher rates of benefit.
Since Madison-area insurers generally cover ECT, it might take a while for TMS to catch on, said Dr. Jerry Halverson, a psychiatrist who is medical director for adult services at Rogers Memorial Hospital in Oconomowoc.
But Halverson said TMS is promising and not as risky as ECT.
“It’s exciting to have more options,” he said.
When Halverson previously worked at Meriter and UW hospitals in Madison, he offered another brain stimulation therapy for depression, called vagus nerve stimulation.
In that therapy, a device implanted under the skin stimulates a nerve thought to help produce certain brain chemicals. Insurers generally didn’t cover the therapy, and it is no longer offered in the Madison area, Halverson said.